四肢前面的深層

1、四肢前面深層解剖廖 華南方醫(yī)科大學解剖教研室2016.09,上肢的深部解剖,胸 肌,Extrinsic musclesPectoralis major 胸大肌 Pectoralis minor 胸小肌 Serratus anterior 前鋸肌Intrinsic musclesIntercostales externi 肋間外肌Intercostales interni

2、 肋間內肌Intercostales intimi 肋間最內肌,,胸大肌Origin: medial half of clavicle,sternum,1th-6th costal cartilages.Insertion: crest of greater tubercle of humerus.Action: flexes, adducts and rotates arm media

3、lly; arm fixed, elevates trunk; elevates ribs 1-6,aidding in forced inspiration.,上肢肌,Muscles of shoulder 肩肌DeltoidsupraspinatusInfraspinatusTeres minorTeres majorsubscapularis,,,Muscles of arm 臂肌Antererior groupB

4、iceps brachii 肱二頭肌Coracobrachialis喙肱肌Brachialis 肱肌Posterior group – triceps brachii肱三頭肌,,,,前臂肌,Superficial layer（第一層）Brachioradialis 肱橈肌Pronator teres 旋前圓肌Flexor carpi radialis 橈側腕屈肌Palmaris longus 掌長肌

5、Flexor carpi ulnaris 尺側腕屈肌,Second layer （第二層） － flexor digitorum superficials 指淺屈肌,,Third layer （第三層）Flexor digitorum profundus 指深屈肌Flexor pollicis longus 拇長屈肌Fourth layer （第四層） － pronator quadratus

6、 旋前方肌Action: flex radiocarpal joint and fingers, pronate forearm,,,腋窩周界及內容,周界: 頂 底 四壁,Axillary fossa 腋窩,The axillary fossa is a pyramid-shaped space through which major neurovascular structures p

7、ass between the thorax and upper extremity,Boundaries 邊界 The apex is a triangular space limited by the first rib, the scapula, and the middle third of clavicle. The base－skin and fascia of the axillary fossa,觀察鎖胸筋膜（鎖骨下

8、肌、胸小肌及喙突之間）及穿行的結構（頭V，胸肩峰A和胸外側N），并修潔之；修潔胸小?。?The anterior wall 前壁Pectoralis major, pectoralis minor and subclavius muscles 胸大、小肌，鎖骨下肌Clavipectoral fascia 鎖胸筋膜The deep faxcia which extends between subclavius, coracoid

9、 process and pectoralis minor musclesThe structures pass through the clavipectoral faxcia 穿鎖胸筋膜的結構Cephalic v. 頭靜脈Thoracoacromial a.胸肩峰動脈Lateral pectoral n. 胸外側神經,Axillary sheath 腋鞘－extension of deep cervical fascia o

10、f the neck, forming a tubular sheath that surrounds axillary a. and v., and brachial plexus,腋動脈 axillary A,被胸小肌分為三段。 第一段 第一肋與胸小肌上緣 （發(fā)出 胸上A）第二段 胸小肌后方(發(fā)出 胸肩峰A、胸外側A)第三段 胸小肌下緣至大圓肌下緣（發(fā)出 旋肱前、后A、肩胛下A）,上肢的動脈,Axillary ar

11、tery 腋動脈Continuation of subclavian artery at lateral border of first ribBecomes brachial artery at lower border of teres majorDivided into three parts by overlying pectoralis minorFirst portion, above muscle－gives ri

12、se to thoracoacromial a. 胸肩峰動脈Second portion, behind muscle－gives rise to lateral thoracic a. 胸外側動脈Third portion, below muscle－gives rise to subscapular a. 肩胛下動脈, anterior and posterior humeral circumflex a. 旋肱前、后動脈; t

13、he former then divides into throcodorsal a. 胸背動脈 and circumflex scapular a. 旋肩胛動脈,臂叢的主要分支,外側束分支 肌皮神經、胸外側神經 正中神經外側根內側束分支胸內側神經、臂內側皮神經、前臂內側皮神經、尺神經、正中神經內側根后束的分支肩胛下神經、腋神經、橈神經、胸背神經、胸長神經,,深層結構觀察胸前筋膜及腋筋膜，并去除之；修潔胸大肌，

14、在距起點2cm處弧形切斷該肌，割斷胸內側神經和胸外側神經，并向外上翻至其止點。,在胸小肌的起點處切斷，并向外上翻；觀察穿過胸小肌的胸內側神經。解剖腋淋巴結，并去除之。觀察腋鞘。解剖腋鞘內結構。,臂前區(qū)解剖,1、保留淺靜脈和皮神經，去除淺筋膜；2、去除深筋膜，修潔臂前群??；3、解剖肱二頭肌內側溝內結構；4、解剖肌皮神經；,,Musculocutaneous n.,,肘前區(qū)解剖,1、保留淺靜脈和皮神經，去除淺筋膜；2、去

15、除深筋膜，修潔肱二頭肌腱膜；3、修潔構成肘窩境界的肌肉；4、剪斷肱二頭肌腱膜；5、解剖肱二頭肌腱膜深面的肱動脈及其分支、正中神經；6、追蹤前臂外側皮神經至肱二頭肌深面；7、在肱肌與肱橈肌之間尋找橈神經，向下追蹤并尋找出橈神經深支和橈神經淺支。,肘前區(qū)解剖,1、剪斷肱二頭肌腱膜；2、解剖肱二頭肌腱膜深面的肱動脈及其分支、正中神經；3、追蹤前臂外側皮神經至肱二頭肌深面；4、在肱肌與肱橈肌之間尋找橈神經，向下追蹤并尋找出橈神經

16、深支和橈神經淺支。,前臂前區(qū)解剖,1、保留淺靜脈和皮神經，去除淺筋膜；2、去除深筋膜，修潔前臂前群肌的淺層各??；橈側到尺側依次為： 肱橈肌、旋前圓肌、 橈側腕屈肌、掌長肌、指淺屈肌、尺側腕屈肌,前臂前區(qū)解剖,1、解剖橈血管、神經束；2、切斷指淺屈肌外側頭，解剖正中神經血管束；3、解剖尺血管、神經束；4、解剖骨間前血管、神經束；5、觀察前臂前群肌深層各肌及其神經支配情況。6、觀察腕管內容,腕橫韌帶,,Mus

17、colocutaneous n.,下肢前部深層解剖－ 關鍵結構,目的與要求 了解股部深筋膜的特點及其所形成的闊筋膜、髂脛束、肌間隔、隱靜脈裂孔等結構;掌握股三角、收肌管和股管的位置、構成及其內容；掌握股動脈的行徑及主要分支、股神經和閉孔神經的分支分布;掌握股前、股內側肌群的名稱和位置關系；掌握脛前動脈的行徑及主要分支；腓總神經與脛、腓骨的關系；腓淺神經和腓深神經的行徑與

18、分布；小腿前肌群和外側肌群的名稱、位置、腱滑液鞘；,深筋膜及肌間隔股前深筋膜增厚特稱闊筋膜，外側份形成髂脛束，恥骨節(jié)結外下方3-4cm處形成卵圓形的薄弱區(qū)——卵圓窩（隱靜脈裂孔）。,,Lacuna musculorum 肌腔隙,Boundaries:Anteriorly: lateral portion of inguinal ligamentPosterolaterally: ilium Medially: iliopec

19、tinal arch Contents: Iliopsoasfemoral n. lateral femoral cutaneous n.,,Iliopectinal arch,Femoral n.,,Iliopsoas,,Lateral femoral cutaneous n.,,,Lacuna vasorum 血管腔隙,Boundaries:Anteriorly: medial portion of inguinal li

20、gamentPosteriorly: fascia of pecteineus and pectineal ligamentMedially: lacunar ligamentLaterally: iliopectinal archContents: Femoral sheathFemoral a. and v.Genital branch of genitofemoral n. Lymphatic vessels,,股

21、三角,境界：上界為腹股溝韌帶，外下界縫匠肌內側緣，內下界長收肌內側緣；前壁為闊筋膜，后壁自外向內依次為髂腰肌、恥骨肌、長收肌及其筋膜。內容：由外向內依次：股神經、股鞘及其包含的股動靜脈、股管,股鞘和股管,股鞘 腹橫筋膜與髂筋膜向下延續(xù)包繞股動靜脈上部形成的筋膜鞘，呈漏斗形，長3-4cm。鞘內有兩個纖維隔，將鞘分隔成三部分： 外側部容納股動脈 中間部容納股靜脈 內側部稱股管 有腹股溝深淋巴結和脂肪

22、股管 前方為腹股溝韌帶，后方為恥骨肌及其筋膜，外側為股靜脈；內側為腔隙韌帶。,Femoral hernia股疝,If a loop of intestine is forced into the femoral ring, it expands to form a swelling in the upper part of the thigh. Such a condition is known as a femoral herni

23、a 股疝.A femoral hernia is more common in women than in men (possibly because their wider pelvis and femoral canal ).,收肌管,收肌管 又稱Hunter管1 構成： 前壁：股內側肌及大收肌間的收肌腱板，淺面覆縫匠肌 外側壁：股內側肌 后內側壁：長收肌與大收肌 上口：股三角尖端 下口：收肌腱裂孔通腘窩

24、2 內容：由前向后 隱神經、股動脈、股靜脈,股動脈分支、股神經皮支、閉孔神經前、后支,操 作 步 驟,(一）股前內側區(qū)解剖1.去除淺筋膜，保留淺血管、皮神經2.去除闊筋膜，保留髂脛束。3.修潔股前群?。汗伤念^肌、縫匠肌4.解剖股三角及其內容（1）觀察股三角的邊界（2）在股鞘前壁作三個縱行切口，顯露其腔內的股動脈、股靜脈和股管。探察股管內容物和股環(huán)的邊界。,,5.解剖收肌管及其內容 縱行切開收肌腱板，修潔收肌管內的隱

25、神經、股動脈、股靜脈等。6.解剖股動脈及其分支（股深動脈、旋股內側動脈和旋股外側動脈、穿動脈）7.解剖股靜脈及其屬支8.解剖股神經及其分支9.解剖股內側群?。盒逎崘u骨肌、長收肌、大收肌、股薄??；暴露其深面的短收??；修潔短收肌淺面的閉孔血管、神經前支；找到其深面的閉孔血管、神經后支,,Saphenous nerve,,deep femeral a.,,Lateral circumflex a.,,,Medial circumfl

26、ex a.,,,,,perforating arteries,股前、股內側肌群,Deep fascia of the thigh,Iliotibial tract 髂脛束 laterally the deep fascia forms a thick band, from the iliac tubercle to the lateral condyle o

27、f tibial. The fascia lata sends intermuscular septa to the linea aspera of the femur. These separate the thigh into three compartments each of which contains a group of muscles, the vessels and the nerves.,,小腿前群、外側群肌肉,

28、,,,伸肌上支持帶,伸肌下支持帶,腓骨上支持帶,腓骨下支持帶,小腿前區(qū),1.去除淺筋膜，保留淺血管、皮神經。2.去除小腿深筋膜，保留伸肌上、下支持帶。3.解剖小腿前群肌：修潔脛骨前肌、拇長伸肌、趾長伸肌和第三腓骨肌。4.解剖脛前血管和腓深神經：在小腿上部，鈍性分離脛骨前肌與趾長伸肌，在兩肌之間、小腿骨間膜前方尋找并清理脛前血管和腓深神經；在小腿下部，鈍性分離脛骨前肌與拇長伸肌，在兩肌之間、小腿骨間膜前方尋找并清理脛前血管和腓深神經